Hope

"You lied to me."

No one had ever said that to me in the hospital before.

"Why did you lie to me?"

Why, indeed?

I'd met her the previous day, when she brought her son to Coptic Hospital in Nairobi, Kenya. I was a fourth-year medical student doing an infectious disease elective at the hospital.

Her son was eight years old and HIV-positive. He had a fever and was breathing fast. Jason, the infectious disease fellow, listened to the boy's back and looked at his X-ray. "Pneumonia," he said.

While the son slept with an oxygen mask on, Jason spoke with the mother: "He is very sick. The first forty-eight hours are the toughest. We can't be hopeful until they're over."

Jason excused himself to go to a meeting. I didn't have a meeting—I barely had a white coat. I sat at the foot of the sleeping boy's bed, across from his mother, where the sheets were stamped "CH" in large, faded blue letters. The mother put a thumbnail between her teeth; folded and unfolded her arms; looked at me and then away. She wore a flowery print dress with lace at the neck, as though she'd been suddenly called away from a garden party.

"What will happen if he can survive this one?" she said to me.

"Well," I said, hesitating, "it depends. He may be developing resistance to the antiretroviral medicines, in which case we would need to switch him."

She looked confused. "You give him new medicines?"

"Maybe. It depends on—" "Better medicines?"

"Well, just different. He won't be resistant to them."

"The new medicines, they will make him healthy?" She leaned forward.

"Well, his viral load should drop, and maybe his CD4 count will rise—"

She tossed off my jargon. "They will make him better?" Her eyes carried not just a question, but a plea.

I paused.

"Yes," I said. "They will make him better." With new medicines, I continued, her son wouldn't get sick as often. He wouldn't need to take prophylactic antibiotics every day. I told her about other children I'd seen, just as sick as hers, who had made complete recoveries. I described their weight gain, their increased energy. How they played soccer in the playground after school, just like the other children.

Her smile was a tiny burst of joy, like the hug of a small child.

When I left, she squeezed my hand. "You are a good doctor," she said.

The boy died later that night, while I was treating myself to a dinner with friends at a Korean barbecue restaurant.

The next morning she was waiting for me. Her face told me more than the empty bed did. Her eyes tore at me with unfocused rage, and despair.

When she called me a liar, I thought of defending myself—reminding her that she had asked me to speculate. I'd only responded to her hypothetical question. But I kept my mouth closed, not wanting to tell another lie. The truth was I had indulged in the fantasy, too. I had taken comfort in imagining her son's long, happy life. Our bedside chat was as much for my benefit as hers.

She yelled in my face: What about the weight gain? What about the soccer in the playground? She wanted me to account for every misleading statement I'd made. Her body trembled with the force of her fury. But a thousand fits of rage would not bring her son back, and she suddenly seemed to realize that. Her hands dropped to her sides. She wept.

She'd asked me to comfort her, and I'd built that comfort from the only material I had: hope. I had done it unthinkingly, instinctively. I had not considered that hope is a shaky scaffolding, and that when it collapses, the fall to earth can be long and the landing hard.

To reach for a straightforward solution is tempting: Be accurate and objective at all times. Tell the whole truth and nothing but the truth. Give your patients a precise dosage of hope...